In India, medical insurance does not play a significant role in hospice and palliative care provision. Services are funded in a range of ways including: central government; state government; NGOs; indigenous-fund raising; private companies; medical and pharmaceutical companies; private individuals and international donations. Many services rely on buildings provided by government or private hospitals but then have to generate their own funds to secure food, drugs, medical supplies and equipment and some salaries. As a consequence, funding is, in the main, a continual source of concern and is often identified by service providers as a limitation upon service expansion. Dr Mary Muckandan outlines the ways in which the palliative care service at Tata Memorial Cancer Hospital, Mumbai, Maharashratra, central India is funded:

We make sure we have enough funds because we have a lot of donors who come forward and help out in many, many ways. It’s all sorts of people, there are individuals who just come and deposit a 500 rupee note in the medical social department and say “please use it for something”. Things come in kind, all sorts of things, food grains, fruits, vegetables, you name it and someone has come and donated it and of course yes there are a lot of companies. Because a lot of the work is not so much for palliative care as such but for chemotherapy of which many will be palliative, but there are companies who are willing to fund, so a lot of money is raised from companies, directly, they pay directly into an account set up for the patients for cancer chemotherapy, if any of those patients turn palliative then we would be able to use those funds from those.²⁸

The other organisation is Careplus, and their focus is on home care of cancer patients who are too poor to travel, or too sick to travel. The per capita income of an average Indian is 250 US dollars, US dollars. And the Careplus, their aim is to identify at least four hundred donors, well wishers who could donate a thousand  Indian rupees. That comes to around 25 US dollars. And with that money they can run this home care program supporting the salary of a doctor, a nurse, fuel for the ambulance, buying dressing materials and the medicines that are needed for home care. And home care is a very good humanitarian service that they are doing, palliative care is taken to the doorstep of the really poor cancer patient.⁵⁶

The difficulties of raising funds are explained by Deepa Muthaiya, Chair DEAN Foundation, Chennai, Tamil Nadu, south India:

There’s nothing sustained, nothing continued and Government funding is almost nil, not almost - it’s just nil because the Government doesn’t believe in palliative medicine or funding for palliative medicine they’d rather pay for an orphan child’s education or something like that they think is more constructive - you see? So, funding is very difficult, we do not have fundraisers because whenever I approach somebody to conduct an event, open up a show for us, they say  - “ Oh! It’s very difficult  because nobody has heard of the Dean foundation”..And our volunteer force is not a consistent group of people in terms of commitment and time; they have their own busy schedules, which means we are just a skeleton and it would be just too much for us to handle. Our day to day admin work and medical work itself is just too much - so we don’t have the time for that. So many times we have thought that we should have a fund raiser in terms of somebody who would be paid on a salary and will only do fund raising but we don’t have the money to do that, you know, so it’s like the chicken or the egg situation . And all our work is free, we give free care.⁴⁶

The Malappuram Initiative in Palliative Care in Kerala, south India (Malappuram has a population of approximately four million) which is part of the Neighbourhood Network for Palliative Care, successfully raises funds through small community donations.  Initiatives include: all buses entering Nilambur bus station contribute two rupees per day; students contribute a rupee every month as part of ‘Palliative Care in Campus’; and regular collections are held at celebrations and festivals.⁵⁸ Dr Numpelli Mathews, the Programme Executive for the Neighbourhood Network for Palliative Care in Malappuram explains:

On a whole 95 per cent of the money spent in Malappuram is being raised from there itself, in nine months in Malappuram itself they are raising about one million, one million rupees from their own area. One hundred thousand people are participating in raising this one million rupees, mostly very small donations, not very large grants, they’re small donations like one rupee donation  boxes placed in shops and houses. Then 50 rupees per month subscription, 100 rupees per month subscription. Then from the students, 2 rupees per month, from the bus owners, bus workers 2 rupees per day, for example.⁵⁹